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| Clinical efficacy of left bundle branch pacing in patients with persistent atrial fibrillation complicating slow ventricular rate |
| ZHANG Yuhang, WANG Yuesong, YANG Da, DONG Xuebin, SHAO Xuwu, WANG Xuezhong |
| (Department of Cardiology, Maanshan Clinical College of Anhui Medical University, the Fifth Clinical Medical College of Anhui Medical University, Maanshan Anhui 243000,China) |
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Abstract Objective To observe the clinical efficacy and safety of left bundle branch pacing (LBBP) in patients with persistent atrial fibrillation (PAF) complicating slow ventricular rate. Methods Fifty-six patients who had undergone pacing treatment due to PAF complicating slow ventricular rate were selected. The patients were divided into right ventricular septal pacing (RVSP) group (29 cases) and LBBP group (27 cases) based on the implantation site of ventricular pacing electrode. Each group was further divided into heart failure (HF) and non-HF subgroups according to clinical symptoms and related examination results. The changes of pacing parameters (such as threshold, perception and impedance), ECG, echocardiography, and plasma probrain natriuretic peptide (NT-proBNP) were observed during operation and 12 months after operation. Other conditions including pacing related complications, re-hospitalization due to HF, newly emerging cerebral infarction and all cause death were also observed. Results(ⅰ) There is no statistically significant difference in pacing parameters between the two groups (P>0.05). The NT-proBNP level of HF patients in both subgroups decreases 12 months after surgery compared with that before, however its reduction in the HF subgroup of the RVSP group is not significant (P>0.05). (ⅱ) In the RVSP group, there is no significant difference in LVEF or LVDd 12 months after surgery compared with that before (P>0.05); LAD signific antly increases (P<0.05) while mitral regurgitation is obviously worsened (P<0.05). In the LBBP group, there is no significant change in LAD or mitral regurgitation 12 months after surgery compared with that before (P>0.05); LVEF increases while LVDd decreases in those with HF 12 months after surgery (P<0.05). (ⅲ) Compared with that before operation, QRS complex duration is prolonged in both groups (P<0.05), and its value in the RVSP group is significantly greater than that in the LBBP group (P<0.05). (ⅳ) There is no significant difference in pacing related complications or cardiovascular and cerebrovascular events between the two groups (P>0.05); the re-hospitalization rate in the RVSP group is higher than that in the LBBP group (P<0.05).Conclusion Among patients with PAF complicated by slow ventricular rate, LBBP helps to delay or reverse left ventricular remodeling of those with HF, improve cardiac function, and reduce readmission rate due to HF. LBBP should be recommended as the preferred pacing treatment method for atrial fibrillation patients with slow ventricular rate.
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